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This dissertation informs the future implementation of HIV prevention for HIV serodiscordant couples in Africa. The research objectives include: 1) reviewing effective HIV prevention interventions, 2) evaluating the use of daily short message service (SMS, i.e. text message) surveys to measure sex and pre-exposure prophylaxis (PrEP) adherence, and 3) examining the acceptability of initiation of antiretroviral therapy (ART) at higher CD4 counts, a powerful HIV prevention tool. After the necessary first step of HIV testing and counseling, HIV serodiscordant couples may be offered appropriate HIV prevention interventions, including condoms, male circumcision, treatment of sexually transmitted infections, and two recent biomedical strategies: initiation of ART by the HIV-infected partner and PrEP by the HIV-uninfected partner. Importantly, the widespread implementation and effectiveness of HIV prevention interventions requires understanding and encouraging behaviors for acceptance, adherence, and correct use. We conducted a prospective study of HIV-related behaviors and qualitative research to answer key implementation questions regarding the feasibility of PrEP and acceptability of early ART among HIV serodiscordant couples. Within a clinical trial of PrEP, we evaluated the use of daily SMS surveys to examine patterns in sexual behavior and PrEP use. Daily SMS data collection was acceptable, obtained high response rates, and provided an assessment of temporal patterns of HIV risk behaviors and PrEP use over a 60-day period. Participants were more likely to adhere to daily PrEP doses when they were sexually-active, PrEP use was not associated with unprotected sex, and anticipating sex was difficult. In addition, HIV risk behaviors were reported on more days through daily SMS surveys compared to monthly interviewer-administered questionnaires, highlighting the potential of SMS to collect more accurate self-reported data. SMS may offer a new method for measuring and promoting behaviors related to HIV risk and adherence as well as enhancing communication between patients and providers. Qualitative research with HIV serodiscordant couples familiar with HIV prevention methodologies highlighted common perceived advantages and concerns related to early initiation of ART, and an important conceptualization of ART as the "final stage" before dying. This negative meaning of ART initiation poses a challenge to acceptance of early ART and indicates that new messages regarding ART initiation are needed. These new messages should emphasize the benefits of HIV prevention and maintaining good health; acknowledge concerns such as side effects and life-long adherence; and ultimately, portray a positive image of individuals on ART. Social and behavioral factors, in particular sustained adherence as well as individual and community acceptance, will be fundamental to successful implementation of early ART and PrEP and should remain a focus of HIV prevention and treatment